Healthcare Provider Details

I. General information

NPI: 1851759757
Provider Name (Legal Business Name): TOTAL LIFE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 LINCOLN WAY APT 2
SAN FRANCISCO CA
94122-1923
US

IV. Provider business mailing address

1533 LINCOLN WAY APT 2
SAN FRANCISCO CA
94122-1923
US

V. Phone/Fax

Practice location:
  • Phone: 301-752-1425
  • Fax:
Mailing address:
  • Phone: 301-752-1425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: ROSE ANN M HAFT
Title or Position: NUTRITIONIST
Credential: MSNIH, CHHC
Phone: 301-752-1425